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Individual

MICHAEL DEREK LAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3918 PECAN GROVE RD, RUDY, AR 72952-9026
(479) 632-6337
(479) 632-5916
Mailing address
3014 W MAIN ST, CHARLESTON, AR 72933-9007
(479) 632-6337
(479) 632-5916

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR1473
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5U320
BLUE CROSS BS PROV.#
AR
Enumeration date
07/06/2006
Last updated
07/09/2007
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